PTC. Report of facility visit for PTC Iraq December Report By Jeanne Frossard and Sir Terence English

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1 Edition 24 CONTACT DETAILS Primary Trauma Care Foundation 313 Woodstock Road, OXFORD OX2 7NY Tel: +44 (0) Fax: +44 (0) Web: Registered Charity Number: PTC IRAQ UPDATE In this edition, we feature: THIS EDITION PTC Facility Visit to IRAQ - Dec st PTC Course - Baghdad, IRAQ Report of facility visit for PTC Iraq December 2009 This PTC project started with a cup of tea shared with Dr Wasan Al Alwan in Jeanne Frossard s flat. Dr Wasan is on the board for CPD for Iraq and she then invited Jeanne and Sir Terence to Baghdad to introduce the PTC concept. There was a conference on Health Resources in Iraq sponsored by the Iraqi Ministry of Health and IMC (International Medical Corporation). This seemed to be the ideal opportunity to make contacts and friends. They travelled to Baghdad via Amman and were kindly met at the airport by Dr Wasan and Dr Yassin, the President of the ICRS. They were transferred via many checkpoints to the Al Rasheed Hotel, a very splendid hotel built in the eighties and this was the conference venue for the International Scientific Conference of Health Resources. They were kindly invited by His excellency, Dr Salih A Hasnawi to take tea and sweets with himself and his lovely family. The workshops started the following day and following a presentation of the principles and work of PTC to approximately thirty key people from surgery anaesthesia and emergency medicine. Jeanne gave a presentation on PTC and Sir Terence chaired the discussion afterwards. The PTC concept was very warmly received. There was a lively discussion to propose recommendations of trauma management in Iraq. The Minister of Health attended part of the workshop. Following the workshop there was a meeting to finalise the proposals attended by Dr Hilal Al Saffar Chairman of the CPD Committee Dr Adel Abdullah Director General of the Ministry of Health Dr Ayad Al Ramadani Chairman of the Arab Emergency Medical board Dr Yassin Almamoury President of the IRCS Dr Omar Salem Khatab Consultant Renal transplant surgeon Dr Waleed Ansari Consultant Anaesthetist, Director of ICU Baghdad Medical city Dr Wasan Al Alwan CPD committee Sir Terence English DR Jeanne Frossard The MOU was signed by Dr Yassin for the IRCS and for the Ministry of Health, on behalf of His Excellency. Plans were made for the first PTC 2/1/2 course to be held at the beginning of April after the elections for security reasons, at the Al Rasheed hotel. Sir Terence travelled back to the UK and Jeanne stayed and gave a lecture at the conference on PTC to an audience of about four hundred people and hopefully made further contacts and friends for the PTC family. There were many enquiries about the course during the conference after the presentation. The Minister of Health was present for the presentation. Jeanne then travelled back to the UK via Amman. The plan was to get instructors from other countries apart form the UK to come and run the course so that the international contacts of PTC were reinforced and there was more communication about PTC between different countries. Report By Jeanne Frossard and Sir Terence English

2 1st Primary Trauma Care Course, Al Rasheed Hotel Baghdad, Iraq 28th March -1st April, 2010 Executive Summary First PTC course in Iraq jointly organised by PTC Foundation, Ministry of Health and Red Crescent Society of Iraq. Five instructors from Pakistan and UK conducted the course; Prof John Beavis, and were joined by Dr Saeed Minhas and Dr Arshad Taqi from Pakistan. Local facilitator of the course was Dr Omar Khatab from Baghdad. The instructors and local facilitators held a precourse meeting after lunch on 27th April, where the logistics were finalized. Participants of the founding course consisted of surgeons, anaesthetists and emergency physicians from Baghdad and Basra to give it a wide geographical representation. A two-day PTC founding course, followed by a one-day instructors course were run. The course was conducted in Al Rasheed Hotel instead of a health facility, keeping in view the security concerns. First session of the course was attended by the President of Iraq Red Crescent Society, Dr Yassin Almamoury. His Excellency, Dr Salah Al-Hasnawi, the Minister of Health of Iraq joined the team of instructors for dinner on the second day of the course and discussed the strategies for adoption of PTC programme in Iraq. Purpose of the Course To introduce and teach the concepts and principles of PTC to the doctors of the various institutions of Iraq. To introduce a programme that trains the healthcare providers to deal with the trauma victims in an organized and timely manner with the available resources. To offer assistance and mutual co-operation to the PTC founding committee of Iraq to implement such a program. Background The present course at AL Rasheed Hotel, Baghdad was the result of an initial effort by Dr Jeanne Frossard and Sir Terrence English with Iraqi officials including Dr Wasan Al Alwan. The report page 2 of this initial visit prepared by is attached. Iraq has gone through a long period of wars and civil unrest and terrorism. The clinicians working there have extensive experience in dealing with trauma. There is a need for a uniform approach to the care of trauma victims; keeping in view a large disparity in resources, manpower and equipment in the country. Primary trauma care programme was identified as a programme that could be widely adopted with the available resources. The first course was designed to develop a core group of clinicians who will take it all over the country. It was kept in mind that the level of course should not be an exhaustive exploration of clinical traumatology but to remain focused on the ABCDE of resuscitation. The format and contents of the lectures, small group discussions and the skill stations were kept realistic with the appropriate models and equipments. Key staff involved in PTC Baghdad Course Faculty Dr John Beavis (Course Director) Dr Arshad Taqi Host Committee Dr Omar Khattab (Consultant Surgeon) Dr Alaa Hussain (Consultant Anaesthetist) Dr Nawfal Ali Mubarak (Consultant Anaesthetist)

3 Overall Timetable Thursday 25th March Arrival of in Baghdad. Friday 26th March Arrival of Dr Arshad Taqi in Baghdad. Saturday 27th March Arrival of Prof John Beavis, and. Precourse meeting with local facilitators. Sunday 28th March 1st Day of PTC Foundation Course. Monday 29th March 2nd Day of PTC Foundation Course. Tuesday 30th March PTC Instructors Course and formation of PTC Iraq Committee. Tuesday 31st March 1st Day of PTC course run by Iraq faculty. Wednesday 1st April 2nd Day of PTC course run by Iraq faculty. Thursday 2nd April Return Flights to UK and Baghdad. Participants of the initial course consisted of surgeons, anaesthetists and emergency physicians who are involved in teaching and training. Equal representation of Basra and Baghdad was meant to ensure a broad geographical dispensation of the programme. Dr Omar Khatab was the local coordinator for the course. Dr Nawfal Ali Mubarak from Basra and Dr. Alaa Hussain from Baghdad facilitated during the sessions. The participants demonstrated great enthusiasm for the course; all of them attended the Instructors course on day 3. Faculty was identified for the course conducted by the local faculty during the following 2 days. A meeting of the faculty was held following the instructor course. 20 Residents of the postgraduate programme in emergency medicine; Medical City Baghdad attended following PTC provider course, which was conducted exclusively by the local faculty. Foreign faculty observed the proceedings. The course was conducted with great precision with very keen and knowledgeable participants. The residents participating in this course came from different areas of Iraq; they will return to their native cities and hopefully become the nucleus of PTC training there. List of Participants Abdullatif Talib Al Hadithi Orthopaedic Surgeon Ahmed Hamid Jasim General Surgeon Ahmed Najim Abdul Nabi General Surgeon page 3 Ahmed R Hizam General Surgeon Alaa Hussein Anaesthetist Amad A Abood General Surgeon Ammar Ehsan Shark Emergency Physician Bashar Tahalali Anaesthetist Bushra Abdul Amar Anaesthetist Hassan Sarhaan Anaesthetist Imad Fahd al Sakram General Surgeon Jassim H. Salim Al Atubi General Surgeon Layla Khalil Ibrahim Anaesthetist Nawfal Ali Mubark Anaesthetist Omar Salem Khaattab General Surgeon Osama Haider Al-Hasany Anaesthetist Rafid AbdulJabbar Mohammed General Surgeon Salah A. AL-Saeed General Surgeon Salam Fadhil Mohammed Orthopaedic Surgeon Course Instructors Professor John Beavis, University College London & Leonard Cheshire Institute for Conflict Recovery, UK, Consultant Anaesthetist, UCLH NHS Foundation Trust, London, UK, Senior Specialty Doctor, Princess Alexandra Hospital, Essex, UK, Asst. Professor & Consultant in Orthopedic Surgery, JPMC, Karachi, Pakistan. Dr Arshad Taqi, Consultant Anaesthetist, Kaul Associates, Hameed Latif Hospital, Lahore Contents and Venue of the Foundation Primary Trauma Care Course The course was held in Al-Rashid hotel due to security concerns. The tables were arranged in a U-shaped fashion, which gave the presenter an access to all participants. Three corners were used for the workshops. Manikins and other teaching aides had to be transported from outside the hotel, which became a serious limitation since some of the training aides; like an airway manikin, could not be arranged. The proceedings started after a 30-minute delay as the Minister for Health was expected to attend the inaugural session. Reducing the duration of the talks during the first session compensated for the delay.

4 The subjects presented during the founding PTC course are outlined in the program. Course content was similar to what is advised in the PTC manual. The instructors used different styles of lecturing and different audiovisual aids, like PowerPoint, whiteboard and group discussion. The lectures were well received by the participants, who were themselves involved in this exercise. The language did not pose a problem as all the participants had a fair knowledge of English. The workshops were a little crowded, given the confines of space but there was ample time for individual interaction. Case scenarios served well for the purpose of team building and leadership exercise, besides emphasizing on important issues of clinical care. Course Program 2 DAY PTC COURSE PROGRAMME DAY minutes Introduction Prof. Beavis/Dr Frossard minutes Local trauma perspective and MCQ Dr Omar Khattab & PTC Team minutes ABCDE of Trauma and Primary survey minutes Airway and Breathing minutes BREAK minutes Circulation and Shock Dr Arshad Taqi minutes Skill stations Basic Airway Advanced Airway/Cervical spine/chest drains Dr Arshad Taqi//Dr Saeed Minhas/Prof Beavis minutes LUNCH BREAK minutes Secondary survey minutes Demonstration Scenario PTC Team minutes Scenarios PTC Team minutes BREAK minutes Chest injuries Prof. John Beavis minutes Overview and summary DAY minutes Head and Spinal injuries minutes Abdominal and Limb injuries Prof. John Beavis page minutes Trauma in Children and Pregnancy minutes BREAK minutes Burns minutes Workshops Analgesia/Transportation/Paediatrics/Neurological assessment Dr Arshad Taqi/Prof Beavis/Shariq Ali/Dr Jeanne Frossard/ minutes LUNCH BREAK minutes Disaster management minutes Scenarios PTC Team minutes BREAK minutes Multiple choice paper PTC Team minutes Summary and evaluation minutes Certificates and close Faculty & Hosts 1 DAY PTC INSTRUCTORS COURSE PROGRAMME minutes Introduction minutes How adults learn minutes Asking questions minutes Feedback How to give presentations 20 minutes General introduction 20 minutes Lecture minutes BREAK minutes Discussion group 15 mins Teaching a skill 15 mins Scenario Prof. John Beavis minutes LUNCH BREAK minutes WORKSHOPS Lecture Discussion group Teaching a skill Scenario Prof. John Beavis minutes BREAK minutes Language issues

5 minutes Instructor course evaluation (evaluation sheet, brainstorming and instructor details form) minutes Where to go from here (Discussion group) Setting up a committee Prof. John Beavis/DrJeanne Frossard/Faculty/ participants & Hosts FINISH Instructor course, Tuesday, 30th March Following the 2 day PTC course all the participants proceeded to take part in the PTC instructor course, which was Directed and convened by. Standard PTC format and presentation were used, with some images added for emphasis by individual presenters. talked about adult learning after introduction by. The standard format of PTC Instructors Course was followed. The participants were very receptive and actively participated in the discussions. Since some of the candidates had to leave and all the remaining ones were keen to complete the instructor course this was opened to 15 doctors. Plan for the following course, which was scheduled to start on the following day and run by the local faculty, was discussed. Faculty for the course was selected; they held a pre-course meeting after dinner. After the course Second course, run by the local faculty was held on 31st March and 1st April 2010, at the same venue, with the international faculty as observers. The instructors were equally divided between Baghdad and Basra. The participants were the postgraduate trainees in Emergency Medicine from Baghdad; they originally hailed from different areas of country. They had a good knowledge of principles of trauma page 5 care; they could appreciate the value of a structured approach to the management of a trauma victim. The course faculty handled the lectures and discussions very well. They used their skills in Arabic very well; switching from English to Arabic whenever some point needed clarification or emphasis. The schedule was followed and time management was very good. The maturity shown by the course faculty and enthusiasm of the participants is very encouraging. These young doctors were particularly enthusiastic about the course and there were many enquiries about becoming instructors. It is Dr Omar s hope that these doctors become involved as instructors for PTC early on. Sadly, it was impossible for people to stay for the formation of the committee at the end of the course but as this has been loosely formed already it was felt the there was enough structure in place to continue PTC. Dr Omar and Dr Alaa are the main organisers in Baghdad and Dr Nawfal in Basra. Dr Taqi kindly set up an internet chat group so that ideas about PTC in Iraq can be shared. Notes on delivery of the Course and lessons learnt Except for the 30 minute delay during the inaugural session, the schedule was followed during both courses. The course was held in the hotel, in a tight security environment. This created a limitation of space as one hall was booked and the open area was not available for the workshops. The medical school in Baghdad has a simulation centre, which would be an ideal place for such courses; the training aides could not be brought to the hotel. The absence of airway manikin, airway management devices, splints etc. was felt during the workshops. The tables were used instead of the couches. These limitations were overcome by some clever improvisations. Video clips demonstrating some of the practical procedures could be a part of our armamentarium, in case the local facilitators cannot arrange appropriate training aides. Evaluation of the success and relevance of the visit An objective evaluation of individual components by

6 the participants is attached, showing that the course was generally well received. The participants did not write many comments on the evaluation form. Most of the comments were appreciative; they are encouraging but do not add to the feedback in order to improve further. COMMENTS OF PTC COURSE Based on the few comments received on the feedback form WHAT WAS THE BEST PART OF THE COURSE? Most of the comments appreciated the value of case scenarios. WHAT WOULD YOU SUGGEST TO CHANGE? 1. Skills stations should have more movie clips. 2. More training aides at the skill stations. Multiple Choice Questions The participants were given the MCQ test to solve before the beginning of the course. They were asked to review their answers at the end of the course to assess the value of the course in increasing their level of knowledge. This was meant for self assessment and not as a test of knowledge. Hospitality The faculty was received at the airport and stayed at Al-Rasheed Hotel, which is situated in the maximum security zone. Movement was restricted to hotel, keeping in view the security of the delegates. They were very well looked after, a senior officer of the ministry of health stayed in the hotel with the participants and faculty to facilitate them. Minister of Health, His Excellency Dr. Salih Mehdi Al-Hasnawi joined the faculty for dinner on the 30th March. Dr Yassin, Head of Iraq Red Crescent Society was also present on the occasion. He discussed his vision of medical education and implementation of PTC programme in Iraq. He extended an invitation to the faculty to visit his native town, the holy city of Karbala. Dr Saeed Minhas and Dr Arshad Taqi accepted the invitation and were taken for an overnight trip as the guests of the Ministry of Health and Iraq Red Crescent Society. page 6 for the completion of this report and for establishing the PTC Iraq cyber group. kindly prepared the attached pre-course report and edited this report and I am thankful for that Professor John Beavis was the most experienced, most learned and fortunately having the best sense of humour amongst us all and the course would have never been such a success without his wise supervision and great laugh. FRCS Course Director PTC Iraq (This report plus an image gallery from the course is now available to read/view online at CONTRIBUTIONS We welcome contributions for forthcoming issues of the Newsletter Course reports and photographs Upcoming course details Country visits All PTC news welcome Please send items to: admin@primarytraumacare.org Acknowledgements I would like to acknowledge the support and hard work put in by the entire faculty during the course, the hospitality and hard work of all the organisers and the enthusiasm of all the participants who made this course a great success. I am especially thankful to Dr Arshad Taqi for his photography, his support